Question Easy:
A 32-year-old woman presents with easy bruising and frequent nosebleeds. Her complete blood count shows isolated thrombocytopenia. What is the most likely diagnosis? 🌟
A) Iron deficiency anaemia
B) Immune thrombocytopenic purpura (ITP)
C) Haemophilia A
D) Von Willebrand disease
E) Thalassaemia
Question Medium:
A 67-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents with shortness of breath and leg swelling. An ultrasound of his leg confirms deep vein thrombosis (DVT). What is the most appropriate initial anticoagulant therapy?
A) Low molecular weight heparin (LMWH)
B) Aspirin
C) Warfarin
D) Rivaroxaban
E) Unfractionated heparin
Question Hard:
A 45-year-old woman with a history of systemic lupus erythematosus presents with fatigue, pallor, and jaundice. Her blood film shows schistocytes. What is the most likely diagnosis?
A) Iron deficiency anaemia
B) Sickle cell disease
C) Autoimmune haemolytic anaemia
D) Thrombotic thrombocytopenic purpura (TTP)
E) Aplastic anaemia
Explanations & Answers:
Question Easy Answer: B) Immune thrombocytopenic purpura (ITP)
Question Easy Explanation: ITP is characterized by isolated thrombocytopenia without a clear underlying cause, leading to bruising and bleeding. The hallmark is a low platelet count with normal white and red blood cell indices. NICE guidelines recommend considering ITP when these symptoms are present, particularly if other causes of thrombocytopenia are ruled out.
Question Medium Answer: A) Low molecular weight heparin (LMWH)
Question Medium Explanation: LMWH is the recommended initial treatment for DVT in patients, including those with comorbidities like COPD, as per NHS guidelines. It provides effective anticoagulation with a lower risk of bleeding compared to unfractionated heparin, and does not require routine monitoring like warfarin.
Question Hard Answer: D) Thrombotic thrombocytopenic purpura (TTP)
Question Hard Explanation: TTP is a rare and serious condition characterized by microangiopathic haemolytic anaemia, thrombocytopenia, and neurological symptoms. The presence of schistocytes on a blood film, along with symptoms affecting multiple systems, strongly suggests TTP. According to NICE guidelines, it requires urgent treatment with plasma exchange.
Medical fact of the day: The ankle-brachial pressure index (ABPI) is a simple, non-invasive test used to diagnose peripheral arterial disease (PAD) in the UK. An ABPI value of less than 0.9 indicates PAD, which warrants further investigation and management to reduce cardiovascular risk.
Quote of the day: “In the tapestry of healthcare, every thread weaves healing, hope, and the relentless pursuit of compassion.”